Updated ACCF/AHA/AACVPR Performance Measures Aim to Increase Patient Referral to Cardiac Rehabilitation Programs, Improve Quality of Care following Cardiac Events

Contact: Amanda Jekowsky, ajekowsk@acc.org, (202) 731-3069

Updated ACCF/AHA/AACVPR Performance Measures Aim to Increase Patient Referral to Cardiac Rehabilitation Programs, Improve Quality of Care following Cardiac Events

Despite lifesaving benefits, only one in five patients receives cardiac rehabilitation


ACC – Amanda Jekowsky: (202) 731-3069; ajekowsk@acc.org

AHA – Maggie Francis: (214) 706-1382; maggie.francis@heart.org

AACVPR – Joanne Ray: (312) 673-4746: jray@aacvpr.org

AUGUST 30, 2010

Cardiac rehabilitation – an organized, medically supervised program of services that might include exercise training, nutritional counseling and group support, among others – can significantly improve the life expectancy and quality of life of people who have had a recent cardiac event, such as a heart attack, angioplasty or heart surgery. Yet, only one in five eligible patients actually receives this lifesaving and life-improving therapy.

To increase the appropriate and timely referral of these patients to outpatient cardiac rehabilitation programs, the American College of Cardiology Foundation (ACCF), the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and the American Heart Association (AHA) today issued updated performance measures. These measures are intended to help hospitals, doctors and other health care providers more easily track referral rates, adopt tools to improve enrollment (e.g., automatic ordering sets), and assess and improve the quality of care provided.

“The gap in referral of patients to cardiac rehabilitation represents the largest gap in care for patients following a cardiac event,” said Randal J. Thomas, M.D., M.S., director of the Cardiovascular Health Clinic at the Mayo Clinic in Rochester, Minnesota, president of the AACVPR and chair of the writing committee. “The updated measures will hopefully help to improve the health of patients with heart disease by increasing the number of eligible patients who are referred to and receive the lifesaving benefits of cardiac rehabilitation.”

According to previous reports, enrollment in cardiac rehabilitation programs has been shown to reduce the likelihood of dying (from all causes) by up to 30 percent.

“These programs can also help prevent future heart-related problems and are generally covered by most health insurance providers,” adds Dr. Thomas. “In addition, other co-existing conditions, such as diabetes, high blood pressure, sleep apnea and depression are identified and managed to make sure that all related aspects of the patient’s heart care are covered and coordinated.”

The underuse of cardiac rehabilitation services is due, in part, to the lack of physician referral either because providers forget to refer patients, are not aware of cardiac rehabilitation services in their area or may not understand the significant benefits to patients. Moreover, patients may lack health insurance coverage and perhaps cannot easily travel to a nearby program, especially if they live in rural areas or in places without good public transportation.

The updated ACCF/AHA/AACVPR performance measures paper reinforces the national focus on health care quality and accountability. But efforts are needed to ensure these measures are translated to clinical practice.

“We must encourage all hospitals and practices caring for patients with heart disease to begin measuring their referral rates to cardiac rehabilitation and then change their care processes to improve those rates,” said Dr. Thomas.

Patients usually participate in cardiac rehabilitation programs for three to six months, and may receive long-term follow up.

This update is also endorsed by other national health care organizations including the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the Clinical Exercise Physiology Association, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.

Full text of this report will be published in the September 28, 2010, issues of the Journal of the American College of Cardiology, and Circulation: Journal of the American Heart Association and the September/October 2010 issue of the Journal of Cardiopulmonary Rehabilitation and Prevention. It will also be available on the ACC (www.cardiosource.org), AHA (www.americanheart.org) and ACCVPR (www.aacvpr.org) web sites.

Dr. Thomas reports no conflicts of interest.


The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 39,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.cardiosource.org.

The American Heart Association, founded in 1924, is the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. To help prevent, treat and defeat these diseases — America’s No. 1 and No. 3 killers — we fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit www.americanheart.org.

The American Association of Cardiovascular and Pulmonary Rehabilitation, founded in 1985, is a multidisciplinary organization dedicated to the mission of reducing morbidity, mortality and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management.  Central to the core mission is improvement in quality of life for patients and their families.  To learn more about AACVPR and our focus on helping heal hearts, lungs and people, or to find a cardiac rehabilitation program near you, visit www.aacvpr.org or call 312-321-5146.


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